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Atrioventricular Conduction in Congenital Heart Disease: by Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

By Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)

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C Right bundle branch and left bundle branches in relation to suture. d Intramural course of right bundle branch 50 Isolated Ventricular Septal Defect Reconstruction of the atrioventricular conduction tissues in the perimembranous outlet-type ventricular septal defect reveals that the major part of the main conduction axis remains left-sided and remote from the crest of the defect. The bifurcating bundle comes closest to the inferior margin of the defect, but can be avoided easily when the anatomy is properly recognized.

22a-f. Micrographs showing course of atrioventricular conduction tissues in same heart. a Penetrating bundle. b Nonpenetrating, non branching bundle. c Branching bundle with needle superficially positioned on right septal side. d Right and left bundle branches. Right bundle branch courses over crest of septum. e Right bundle branch in intramural position. f Peripheral subendocardial position of right bundle branch 42 Isolated Ventricular Septal Defect The reconstruction of the atrioventricular conduction tissues in this specimen reveals the close relationship between the conduction tissues and the borders of the defect.

Right ventricular view of an unusual variant of perimembranous outlet-type ventricular septal defect. The defect is oval in shape with its long axis directed obliquely anterior and superior Perimembranous Ventricular Septal Defect Fig. 32. Left ventricular view of same heart 53 54 Isolated Ventricular Septal Defect From a surgical point of view this type of defect is of interest, since the penetrating bundle comes very close to the posteroinferior angle of this defect, at the site where the trabecula septomarginalis and the membranous septum meet.

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